Healthcare Provider Details

I. General information

NPI: 1275539702
Provider Name (Legal Business Name): NARINDER P BHALLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 MITYLENE PARK LN
MONTGOMERY AL
36117-7302
US

IV. Provider business mailing address

185 MITYLENE PARK LN
MONTGOMERY AL
36117-7302
US

V. Phone/Fax

Practice location:
  • Phone: 334-387-0948
  • Fax: 334-387-0956
Mailing address:
  • Phone: 334-387-0948
  • Fax: 334-387-0956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101221234
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number28644
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: